It was a big debate last summer. While children’s dental coverage is one of the Affordable Care Act’s 10 essential health benefits, the ACA gives states the flexibility to offer the coverage in a stand alone plan. Covered California first required insurers to include children’s dental, then told them to strip out the benefit, in favor of offering stand alone plans at an additional cost.

Now the data is in. Less than one-third of enrolled children on Covered California through 2013 also has dental coverage. Executive director Peter Lee says the additional cost appears to be on issue. “A lot of folks are low income,” he said. “They’re thinking additional coverage versus food on the table.”

Covered California’s board voted Thursday to make a change. Starting in 2015 all medical plans for children sold through the marketplace will be required to include dental coverage.

Kathleen Hamilton of The Children’s Partnership, an advocacy group, said she was “very pleased, very excited by the 180 degree turn” that the board took.

She said that many people misunderstand how severe dental disease can be in children and its connection to overall medical health. “If kids have dental disease, their nutrition is impaired because they can’t eat properly,” she said. She added that children miss school due to pain and dental infections. The pain may lead to poor sleep — and sleep deprived children have more trouble paying attention in school.

Some dental insurers disagreed with the board’s move. Delta Dental’s Jeff Album says the change will encourage medical insurers to partner with less-expensive HMO dental plans that may have a limited number of providers.

“That means everyone in 2014 in a PPO stands a very good chance of losing their dentist,” Album said. “They’re going to have about half the choice that they have today.”

Hamilton agreed that availability of providers is an issue. She said that Covered California and the Department of Health Care Services, which oversees the state’s Medi-Cal program, still must work “to ensure that networks are adequate and that families have access to dentists in their communities.”

Covered California says it may allow people to buy extra dental coverage if they want to keep their dentist.

The state’s health insurance marketplace, Covered California, authorized a set of benefits months ago that included dental care for children, but now the marketplace is telling insurance companies to strip out the dental coverage. People would then have to pay extra for a dental plan for their children.

California’s insurance commissioner Dave Jones warns the move could reduce children’s access to dental care and urged Covered California to include the benefit in plans that will be sold when the marketplace formally opens October 1. The change will also drive up costs for consumers, he says.

In a June 27th letter to the board that runs Covered California, Jones says he talked with insurers that originally submitted bids to sell their products on the state’s marketplace and argues dental care is essential. “A child’s overall health and well-being requires access to dental care to ensure oral health,” he wrote.

Covered California is the state’s new health insurance exchange set up as part of the federal health law. It will open Oct. 1 and will be a place where individuals can shop for health insurance which will go into effect Jan. 1. Covered California’s website still shows pediatric dental services as a covered benefit under its health insurance plans. The Affordable Care Act does not require that health plans include dental coverage for children.

Dana Howard, a spokesman for Covered California, argues its move is about consumer flexibility.

“I understand what he’s concerned about, but Covered California likewise is concerned about good dental coverage,” Howard said. The change “is simply to provide more options for the families to have a stand-alone plan, so they can have a broader choice of the networks or the plans that they would wish to have cover their children.”

Howard says they were able to make the change and still offer plans that are affordable. Covered California will offer nine different plans for children ranging in price from $8to $35 a month.

“You have to look at the reason why people don’t buy dental insurance for their children, and we believe we’ve answered that problem.” Howard said.

But at least one major insurer who bid to sell plans on the state’s marketplace told the commissioner it had planned to offer children’s dental for $6 a month as part of a larger package, but will now charge $26 a month for the separate product.

Covered California’s board is expected to sign contracts for health insurance plans this week, in effect locking in the decision to separate children’s dental care.